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APPLICATION TO MEMORIAL UNIVERSITY OF NEWFOUNDLAND RESIDENCY TRAINING PROGRAMCORE CLINICAL CLERKSHIP DETAILS FOR INTERNATIONAL MEDICAL GRADUATES Name of applicant: Name of medical school: Duration of basic medical degree program: Start date: End date: Core clinical clerkship rotationsIndicate the year(s)core clinical clerkships completed(e.g. 4th year, 5th year)Name of hospital/clinic and location where rotation completedIs this facility a university affiliated *teaching hospital?Indicate YES or NOStart & end datesof rotation (use format dd/mm/yy)& duration: (e.g. 8 weeks)Internal MedicineFacility:YESNOStart date:City:IF YES, PLEASE INDICATE NAME OF UNIVERSITY:End date:Country:Duration:SurgeryFacility:YESNOStart date:City:IF YES, PLEASE INDICATE NAME OF UNIVERSITY:End date:Country:Duration:PediatricsFacility:YESNOStart date:City:IF YES, PLEASE INDICATE NAME OF UNIVERSITY:End date:Country:Duration:Obstetrics/GynecologyFacility:YESNOStart date:City:IF YES, PLEASE INDICATE NAME OF UNIVERSITY:End date:Country:Duration:PsychiatryFacility:YESNOStart date:City:IF YES, PLEASE INDICATE NAME OF UNIVERSITY:End date:Country:Duration:* A teaching hospital is a hospital that provides clinical education and training to future and current doctors, nurses, and other health professionals, in addition to delivering medical care to patients. They are affiliated with medical schools or universities (hence the alternative term university hospital), and may be owned by a university or may form part of a wider regional or national health system.** If the rotation has not yet been completed, indicate scheduled start and end dates. ................
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